MarkT
Forum Replies Created
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I’ve had left and right side inguinal repairs at Shouldice Hospital, both a long time ago (one side was a little over 30yrs ago, the other about 20yrs ago). No post-op complications, no chronic pain or any ‘odd sensations’ since then, and no restrictions on any activity (sports, weights, yoga, swimming, etc.)
It’s been a long time, so details are fuzzy, but I do remember getting occasional ‘twinges’ of pain as I healed…a brief, sharp pain, sometimes if I moved or turned too quickly and forgot I wasn’t ‘100%’ yet, for example. To be clear, it was occasional, momentary, and not terrible pain…and it completely went away over the short-term. I just can’t remember the timeline, sorry…but it was a matter of weeks or maybe a few months…certainly not ‘long-term’ or chronic, and clearly just part of the healing process.
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I have not watched any of the videos…but does he say anywhere what type of tissue repair he does following removal?
I wonder how many he is doing, given that he appears to be a single-surgeon clinic and offers so many others services.
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That is not a lot of material…and 30cm of thin suture is nowhere near the same amount of material in even the smallest pieces of mesh that are used in hernia repair, never mind the pieces that are used to cover a larger area when deemed appropriate.
Also, are you considering only the incision or the total length of suture used to complete the repair? I honestly have no idea, but are you sure that Dr. Kang only uses 7cm of sutures in total?
In any case, it is not appropriate to evaluate and compare the quality of repairs on the basis of suture length…you evaluate quality (at least from a patient perspective) on the basis of outcomes. So unless there is solid evidence that suggests ‘more suture material = more post-op complications’, then there is probably not a good reason to worry about such differences.
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I would strongly recommend that you seek to address your psychological symptoms instead of looking toward a surgical solution for a problem that exists only in your head, for a number of reasons:
– You have no physical symptoms of injury/illness that warrant surgical intervention.
– There is no reliable evidence that modern non-symptomatic hernia mesh implantation may lead to cancer.
– A surgeon will surely face ethical barriers to removing mesh in the absence of a medically sound rationale for doing so.
– Mesh removal is not a ‘routine’ matter and you would be absorbing all of the risks associated with a 2nd surgery to remove the mesh and re-repair the hernia defect. The likelihood of chronic pain and hernia recurrence will be higher vs. simply leaving the non-symptomatic mesh in now.
Seek help…speak with a mental health professional…there is no need to suffer with these thoughts on your own. I suspect that cognitive behavioural therapy (CBT) would be an effective option for addressing your psychological symptoms.
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Honestly, not loving the new format so far, but I understand there will be challenges and an adjustment period with any change and that everyone is working hard to work out the wrinkles which is certainly appreciated.
– On the feed, the response box has suddenly closed for me in the middle of typing a comment four times today. At first I thought it was a short-cut key issue, but then I was pretty careful typing one response and it still happened.
– I’m sure everyone has seen that the drug-ad spammers are back…yesterday, there were at least a half-dozen in a row clogging up the news feed. I’m not sure if that can be dealt with during the registration or posting process with something like a reCAPTCHA-type authentication? Perhaps the worst-case might be implementing a restriction whereby new members have ‘read-only’ access and can’t post anything until a moderator approves their account, but I imagine that an active moderation solution is not ideal and that something automated would be preferable.
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Kind of? I think their criteria is that a hernia must be palpable upon physical examination. Difference being that it might be possible to feel a small hernia upon examination without a noticeably visible bulge, correct? In any case, they do not rely upon imaging…it must be physically detectable.
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No, this ‘my friend said…’ post does not change the algorithm, because further information is needed.
1. Does this increased risk actually exist, and (if so) is it unique to Shouldice?
2. If so, what is the natural risk and what is the increased risk?
3. How does this increased risk factor into the overall list of risks/benefits associated with Shouldice and the other repair options?(You can get even deeper into the weeds and wonder if the increased risk is the same for every Shouldice patient or does it depend upon certain surgeon/patient/hernia factors, but we’ll keep it simple).
I’ll give you an example of how a context-free ‘increased risk’ claim is not only unhelpful, but might even lead you to make the wrong decision for yourself.
As part of a broader talk years ago, a statistician recounted her doctor advising her to have an induced (vs. natural) childbirth to avoid ‘doubling the risk of miscarriage’ in her situation.
That sounds scary as heck, doesn’t it? Shouldn’t that be an EASY decision? Surely she would want to avoid DOUBLING her risk of having a miscarriage, right?
Not so fast. It turned out the natural risk was 1 in 1000 (0.1%), so the doubling only resulted in the risk rising to 2 in 1000 (0.2%). Coupled with other reasons (which relates to my third question), she elected not to be induced.
Context matters.
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Hi Peter,
Thanks for the update. I’m glad you decided to consult with Dr. Conze, even though you no doubt hoped for a better result.
What did Dr. Conze hypothesize might result from his idea to put back all tissues to their anatomical position? Despite a ‘return to normal’ being off the table, is there some improvement that might result from what he proposed (basic functioning, pain reduction, etc.)?
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“…or the german surgeons for shouldice. Then you just down shift your life to walking and water aerobics.”
LOL – what utter nonsense.
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Is there any evidence that lifting belts (or other ‘protective’ gear/clothing) help prevent primary hernias or recurrences though?
I did a very quick search on lifting belts and located several studies that found their use increases intra-abdominal and intra-thoracic pressure at certain points during certain lifting exercises, may provide a performance-enhancing benefit allowing subjects to lift more weight, and may provide a modest reduction in stress on spinal discs. I did not find anything that suggested a preventative effect for primary hernias or recurrences though.
I know that some medical device sites, and even some hernia surgeons’ sites, suggest that ‘protective clothing’, such as belts and trusses, may not merely help manage hernia symptoms, but may actually help prevent hernias and recurrences…but is this evidence-based advice?
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Terrible story…I hope he manages to get some relief. It would still be nice to get both sides. Also, best to post the entire review, verbatim…seems the first paragraph was omitted and there is at least one other minor change?
On the one hand, the patient had two expert opinions that clearly contradicted the option in front of him, yet he chose to proceed. He also travelled from the U.K. to Germany and paid for a procedure prior to having the details? I understand that the already incurred expenses put him on the spot and made it harder to walk away…still, this was not an emergency situation, so postponing to gather more info would have been wise. Of course, hindsight is 20/20.
Having said that…IMHO, Dr. Koch and his staff arguably should have cancelled the surgery pending more in depth discussions (at least based on the patient’s side of the story) as this seems to be more than your typical case of ‘pre-surgery jitters’. On two occasions, and to three different people, this patient clearly expressed that he was very uncomfortable proceeding with the surgery, and he provided contradictory expert opinions that appear to not have been directly addressed. At that point, he is arguably withdrawing consent…and I question the ethics of persuading him to go forward, regardless of his subsequent agreement being ‘sufficient’ to proceed.
It remains murky the degree to which the patient felt ‘pressured’ to proceed vs. the staff’s position that he was merely ‘reassured’ and agreed to proceed.
At this point, I would do two things, if I were him:
1. Go back to Dr. Koch. I think it is a *huge* mistake to not follow-up with him again. First, the surgery otherwise goes down as a ‘success’ in his records (assuming data is kept) because his questionable advice of ‘herbal supplements’ will be presumed to have worked or that the pain otherwise resolved, if they don’t hear from the patient again. This is NOT to say he should actually proceed with Dr. Koch any further…but he should hear him out, challenge him to explain the result, and get him to provide a recommendation on how to proceed from here.. It could yield info for subsequent consults with other doctors and for pursuing the matter further, which leads to my next point…
2. I would strongly consider following up with the governing medical body in Germany. Nothing ‘illegal’ appears to have happened (and certainly not that be proven anyway, as it will be a case of the patient claiming he was ‘pressured’ to the staff saying they ‘reassured’ him) but it could potentially be pursued on ethical grounds. IMHO, it would have been wise for this surgery to have been postponed for the reasons outlined above.
Again, these feelings are entirely based on the patient’s side of the story. I also have zero knowledge of what is appropriate from a surgical perspective for this patient’s problem or regarding mesh removal…I’m approaching this solely from their patient-doctor interaction and an ethical perspective.
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I think those clothing recommendations are more for comfort than anything, and I highly doubt they serve to prevent recurrence.
Generally speaking, you should not be able to damage an inguinal hernia repair with normal activity after surgery and resumption of light to moderate physical exercise is essentially based upon a patient’s pain tolerance during recovery.
Atypical repair cases or resuming more intense activities (e.g., returning to sports, weight lifting, etc.) should probably be discussed with your surgeon. There are a wide variety of recommendations out there on whether (and to what extent) activities of various kinds should be restricted.
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Where are you located?
@drtowfigh might be able to recommend someone, since that is an area in which she has experience and a particular interest.
I will link a previous thread below that includes the dynamic MRI protocol she recommends, but what other testing has been done so far that is leading you to suspect an occult hernia?
https://herniatalk.com/forums/topic/suspected-occult-hernia-25f/
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“I see lots of failures on the forums” is not evidence…that is just you talking.
“These are probably much more likely to last…” is not based on any good evidence…you are basing that on an illogical opinion. You can’t first note that there is no long-term data for Kang, then claim that something else is probably more likely to last than Kang. If there is no data, there is no data…you can’t make a probability claim without any data.
For most patients with unremarkable inguinal hernias, the likelihood of recurrence is VERY low across repair types that are done by a hernia speicalist…so basing your choice of which primary repair to get by which may easier to fix in the very unlikely event that it fails, seems rather misguided.
Get a repair that is appropriate for your particular situation, and get it done by someone who is an experienced expert with that repair. That’s the best you can do.
There is no ‘clarity’ that is going to point to one repair or surgeon above all others, so you may as well stop searching for it.
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Depending upon the type and nature of your hernia, and your own characteristics (health, BMI, etc.), I would highly recommended a free consult at Shouldice Hospital, where surgeons specialize exclusively on the Shoudlice tissue repair.
It seems that in Ottawa or Montreal you will otherwise likely be looking at an open or laparoscopic mesh repair by a general surgeon in a public hospital or private clinic, who by comparison would do far fewer hernia repairs (which is not to say none of them are any good – just that finding a hernia specialist is the ideal).
I’m not aware of any ‘hernia-only’ specialists in Montreal or Ottawa, but perhaps someone will chime in if they have more info.
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Yes, have to keep in mind this is an online convenience sample and not to be taken as representative of all surgeons or hernia specialists.
Worth a read, though it is really about collecting global perspectives on what is practised or believed vs. providing any evidence of what is ‘best’. About 44% of respondents were in Europe, 40% in SE Asia or Australia, 15% in the Americas, and 2% in Africa, and there was a fair bit of variation in years of experience and # of repairs performed.
There is a quite a lot of information compiled from the survey…I thought I could try to summarize it, but it is a bit much. In addition to demographic info, including surgeon experience and volume, it captured their preferences/opinions regarding: repair methods, type of mesh, sutures, fixation methods, treatment of nerves, anaesthesia, contraindications for repair types, complication rates, complication risks disclosed during consent process, and more.
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As I have done here in the past, I would caution readers against simply accepting the conclusions of authors without taking a deeper dive…
I had a quick look at the study <font face=”inherit”>concluding less pain with absorbable sutures vs. non-absorbable (Patel et al., 2019) since I found it interesting that suture material would be implicated as meaningfully relevant.</font>
<font face=”inherit” style=”font-family: inherit; font-size: inherit;”>Note the study had a small sample size, a short (inadequate) follow-up timeframe, and (IMHO) a problematic and overly simplistic methodology. Marginally statistically </font>significant<font face=”inherit” style=”font-family: inherit; font-size: inherit;”> findings aside, it is simply not possible to conclude from this study that any difference in pain was attributable to the suture material. The authors do not appear to have accounted for various patient, hernia, or surgeon characteristics (many of which have been implicated as relevant to post-op outcomes), and merely randomizing patients into suture groups does not address this shortfall. Further, they even noted that some patients had bilateral repairs, and in their own limitations acknowledge that different surgical teams were involved, yet apparently accounted for neither. </font>Personally, I would place very little weight on the conclusions from this study.
As an aside, it is also worth keeping in mind that there is quite a difference between ‘foreign body’ issues with mesh vs. sutures, given the size and placement of mesh and given that concerns with mesh extend well beyond inflammation.
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To say that it is not a matter of ‘if’ but ‘when’ a Shouldice repair will fail is utter nonsense…so i<font face=”inherit”>f Chen and your doctor said that, they are either shamefully dishonest or </font>embarrassingly<font face=”inherit”> ignorant.</font>
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Yes, I’m aware too…I respond mainly for the benefit of other readers coming to the forum who might otherwise become misinformed or unnecessarily concerned by such posts.
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Without getting into a big story, there is not *great* long-term data on hernia repair in genera, never mind on relatively new mesh products that don’t have decades of use behind them. Despite this, there is still not a good reason to believe that modern hernia meshes will result in health problems down the road such as cancer…and we still know that a sizeable majority of hernia patients will enjoy problem-free repairs. You can take some solace in this…chances are, you will be fine!
I strongly agree that psychological pain is real pain…and for this very reason, a mental health professional should be consulted. Just as we seek a doctor when we have physical pain, we should seek out professional help when we have psychological pain. You would not be expected to fix your own broken arm, so why would you be expected to fix your own depression or anxiety?
Your psychological symptoms warrant a psychological intervention, and a qualified therapist will be able to help you with this.